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Background Quality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators’ perspective, when applied in debriefings. Methods A set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis. Results Three themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE , points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity , shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved , turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity. Conclusions This study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect.

Background Healthcare students are taught teamwork and collaboration through interprofessional simulation-based education (IPSE). However, the complex nature of healthcare and the ability to react resiliently to the unexpected is usually not actively addressed. This study explores how complexity and resilience can be addressed in IPSE debriefing for pre-graduate healthcare students. Methods A focus group of nine facilitators in an IPSE course for nursing and medical students was introduced to the characteristics of complex systems, Safety-II, solution-focused approach, and appreciative inquiry. In five iterations, the facilitators discussed how these theories and methods could be applied, tested, evaluated, and adjusted in debriefings supported by video clips of their own debriefings. Video recordings of debriefings ( n  = 56) and focus group interviews ( n  = 6) were collected. Focus group interviews were transcribed and reviewed to explore the basis for final recommendations. Results Facilitators identified and tested 22 debriefing techniques that potentially could address complexity and resilience in IPSE. In total, 17 of the tested techniques were found to be able to make students aware of the complex nature of interprofessional teamwork and collaboration in acute dynamic healthcare situations, their existing capacities for resilience, potentially increasing their capacity for resilience. Conclusions Learning needs around resilience and complexity could be addressed successfully in IPSE debriefings, but further studies are needed to assess the effect of resilience-focused debriefing techniques on teamwork in IPSE.

Background This study explores how interprofessional simulation-based education (IPSE) can contribute to a change in students’ understanding of teamwork and professional roles. A series of 1-day training sessions was arranged involving undergraduate nursing and medical students. Scenarios were designed for practicing teamwork principles and interprofessional communication skills by endorsing active participation by all team members. Methods Four focus groups occurred 2–4 weeks after the training. Thematic analysis of the transcribed focus groups was applied, guided by questions on what changes in students’ understanding of teamwork and professional roles were identified and how such changes had been achieved. Results The first question, aiming to identify changes in students’ understanding of teamwork, resulted in three categories: realizing and embracing teamwork fundamentals, reconsidering professional roles, and achieving increased confidence. The second question, regarding how participation in IPSE could support the transformation of students’ understanding of teamwork and of professional roles, embraced another three categories: feeling confident in the learning environment, embodying experiences, and obtaining an outside perspective. Conclusions This study showed the potential of IPSE to transform students’ understanding of others’ professional roles and responsibilities. Students displayed extensive knowledge on fundamental teamwork principles and what these meant in the midst of participating in the scenarios. A critical prerequisite for the development of these new insights was to feel confident in the learning environment. The significance of how the environment was set up calls for further research on the design of IPSE in influencing role understanding and communicative skills in significant ways.

Background Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants’ reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace. Methods In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis. Results All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one’s profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration. Conclusion Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

[This corrects the article DOI: 10.1186/s41077-017-0041-6.].

Background The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out. Methods A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings. Results The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication. Conclusions In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

This study contributes to social studies of imaging and visualization practices within scientific and medical settings. The focus is on practices in radiology, which are bound up with visual records known as radiographs. The study addresses work following the introduction of a new imaging technology, tomosynthesis. Since it was a novel technology, there was limited knowledge of how to correctly analyse tomosynthesis images. To address this problem, a collective review session was arranged. The purpose of the present study was to uncover the practical work that took place during that session and to show how, and on what basis, new methods, interpretations and understandings were being generated. The analysis displays how the diagnostic work on patients' bodies was grounded in two sets of technologically produced renderings. This shows how expertise is not simply a matter of providing correct explanations, but also involves discovery work in which visual renderings are made transparent. Furthermore, the results point to how the disciplinary knowledge is intertwined with timely actions, which in turn, partly rely on established practices of manipulating and comparing images. The embodied and situated reasoning that enabled radiologists to discern objects in the images thus display expertise as inherently practical and domain-specific.

Because simulators offer the possibility of functioning as authentic representations of real-world tasks, these tools are regarded as efficient for developing expertise. The users' experience of realism is recognised as crucial, and is often regarded as an effect of the similarity between reality and the simulator itself. In this study, it is argued that simulation as a realistic and relevant activity cannot be predesigned but emerges in the interaction between the participants, the simulator, and the context. The study draws on interaction analysis of video data from medical training. The aim is to contrast the use of two different simulators to explore the requirements needed to establish and maintain simulations as authentic representations of clinical practice. Irrespective of the realism of the simulator, glitches in the understanding of the simulation as work-related activity appear and are bridged by participants. This regularly involves an orientation to the relevant similarities with work and, simultaneously, the ruling out of irrelevant dissimilarities. In doing so, the participants rely on established professional practices to construe the situation. Moreover, the realism of the simulation is maintained through the participants' mutual orientation to the moral order of good clinical practice and a proper simulation. It is concluded that the design of simulation activities needs to account for the possibilities of participants understanding the specific conditions of the simulation and the work practices that the simulation represents. Learning to simulate is thus something that needs further attention in its own right.

Through close analyses of the interaction that takes place between students and facilitators, this study investigates the instructional use of video in post-simulation debriefings. The empirical material consists of recordings of 40 debriefings that took place after simulation-based training scenarios in health care education. During the debriefings, short video-recorded sequences of the students’ collaboration in the scenarios were shown, after which the facilitators asked the students questions about the teamwork and their performance as displayed in these sequences. The aim of the study is to show: a) how the video is consequential for the ways in which the students talk about the teamwork and their own performance; b) how the facilitators’ questions guide the students’ contributions and collaborative sense making of prior events. Regularly, the facilitators’ questions were posed in terms of “seeing”. The design and sequential environment of the questions made it relevant for the students to comment on how the displayed situations appeared audiovisually and how these appearances contrasted with their experiences from the situation. In this way, the video enabled the students to talk about their own conduct, including their collaboration with their peers, from a third-person perspective. The study highlights the central role of instructions and instructional questions in the debriefings, how the video was used to make the students reconceptualise their performance together with others, and the importance of contributions from fellow students.

Electronic patient records (EPRs) are a constitutive element of medical practice and are expected to improve interprofessional communication and support decision making. The aim of the current study is to explore the ways in which access to structured information from multiple professions within EPRs enters into the phases involved in arriving at final agreements about patients' future care. The results show that decision making in interprofessional team rounds involves a prestructuring of a pathological reality. Further, the results demonstrate how information in EPRs is deconstructed and recast into patterns that presuppose knowledge about the EPR's structural organization. This means that EPRs are highly flexible technologies and that their design does not determine their usefulness. A major conclusion is that the members' knowledge on how to bridge between standardized categories in EPRs and their local meanings is decisive for understanding the basic conditions necessary for how EPRs could support interprofessional collaboration.